Very Preterm Birth is Reduced in Women Receiving an Integrated Behavioral Intervention: A Randomized Controlled Trial
Very Preterm Birth is Reduced in Women Receiving an Integrated Behavioral Intervention: A Randomized Controlled Trial
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DOI：
10.1007/s10995-011-0843-4
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发表时间：
2011-01-01
影响因子：
2.3
通讯作者：
El-Khorazaty, M. Nabil
中科院分区：
文献类型：
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作者：
El-Mohandes, Ayman A. E.;Kiely, Michele;El-Khorazaty, M. Nabil
本研究探讨了在非洲裔美国人中，经证实有效降低心理行为风险（吸烟，环境烟草烟雾暴露（ETSE），抑郁症和亲密伴侣暴力（IPV））的综合行为干预是否与改善妊娠结局相关。在哥伦比亚特区进行了一项针对妊娠期风险的随机对照试验。非裔美国妇女被招募，如果报告至少一个上述风险。干预或常规护理的随机化是部位和风险特异性的。收集社会人口学、健康风险和妊娠结局数据。使用意向治疗方法分析了819名妇女及其单胎活产婴儿的数据。双变量分析之前，减少逻辑模型的方法，以阐明干预措施对减少早产和低出生体重的影响。低出生体重儿（LBW）的发生率为12%，极低出生体重儿（VLBW）的发生率为1.6%。多因素Logistic回归分析结果显示，抑郁与低出生体重相关（OR = 1.71，95% CI = 1.12-2.62）。IPV与早产（PTB）和极早产（VPTB）相关（OR分别为1.64，95%CI = 1.07-2.51，OR = 2.94，95%CI = 1.40-6.16）。与常规护理组相比，干预组VPTB的发生率显著降低（OR = 0.42，95%CI = 0.19-0.93）。我们的研究证实了多种心理行为风险与不良妊娠结局（包括LBW和PTB）之间的显著相关性。我们的行为干预在解决多个危险因素同时减少VPTB在城市少数民族人群中表现出的疗效。
This study examines whether an integrated behavioral intervention with proven efficacy in reducing psycho-behavioral risks (smoking, environmental tobacco smoke exposure (ETSE), depression, and intimate partner violence (IPV)) in African-Americans is associated with improved pregnancy outcomes. A randomized controlled trial targeting risks during pregnancy was conducted in the District of Columbia. African-American women were recruited if reporting at least one of the risks mentioned above. Randomization to intervention or usual care was site and risk specific. Sociodemographic, health risk and pregnancy outcome data were collected. Data on 819 women, and their singleton live born infants were analyzed using an intent-to-treat approach. Bivariate analyses preceded a reduced logistical model approach to elucidate the effect of the intervention on the reduction of prematurity and low birth weight. The incidence of low birthweight (LBW) was 12% and very low birthweight (VLBW) was 1.6%. Multivariate logistic regression results showed that depression was associated with LBW (OR = 1.71, 95% CI = 1.12-2.62). IPV was associated with preterm birth (PTB) and very preterm birth (VPTB) (OR 1.64, 95% CI = 1.07-2.51, OR = 2.94, 95% CI = 1.40-6.16, respectively). The occurrence of VPTB was significantly reduced in the intervention compared to the usual care group (OR = 0.42, 95% CI = 0.19-0.93). Our study confirms the significant associations between multiple psycho-behavioral risks and poor pregnancy outcomes, including LBW and PTB. Our behavioral intervention with demonstrated efficacy in addressing multiple risk factors simultaneously reduced VPTB within an urban minority population.